ICD 10 Code Set Update National Association of Health Data Organizations October 14, 2010
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1 ICD 10 Code Set Update National Association of Health Data Organizations October 14, 2010 Hetty Khan, BSN, MSN Health Informatics Specialist Classifications and Public Health Data Standards National Center for Health Statistics/CDC 1
2 Overview of ICD 10 CM and ICD 10 PCS NCHS overview ICD 10 code set final rule Overview of ICD 10 CM and ICD 10 PCS General Equivalence mappings (GEMs) Transition issues/considerations 2
3 What is the National Center for Health Statistics (NCHS)? The National Center for Health Statistics is The nation s principal health statistics agency Part of the Centers for Disease Control and Prevention that monitors the health of the Nation Provides data to assess health care trends, the health status of the population and the effectiveness of health policy decisions and programs
4 How are National Health Care Survey (NHCS) data used? To understand health care practice To identify and track problems To identify inequalities in the provision of services To establish national priorities To serve as comparison points for states To measure Healthy People objectives
5 National Health Care Surveys Includes: National Ambulatory Medical Care Survey (NAMCS) National Hospital Ambulatory Medical Care Survey (NHAMCS) National Home & Hospice Care Survey (NHHCS) National Nursing Home Survey (NNHS) National Hospital Discharge Survey (NHDS) National Survey of Ambulatory Surgery (NSAS)
6 ICD Revisions ICD Revision No. Year of Conference When Adopted Year in Use in the U.S. First ICD, Clinical Modification Year in Use in the U.S. Second Third Fourth Fifth Sixth Seventh Eighth ICDA 8 H ICDA 1 H ICDA 2 Ninth ICD 9 CM Tenth ICD 10 CM Oct. 1,
7 ICD 10 Code Sets Final Rule CMS 0013 F Published January 16, 2009 October 1, 2013 Compliance date for implementation of ICD 10 CM and ICD 10 PCS (no delays or grace periods ) pdf 7
8 ICD 10 Final Rule Single implementation date for all users Date of service for ambulatory and physician reporting Date of discharge for inpatient settings ICD 9 CM codes will not be accepted for services provided on or after October 1, 2013 ICD 9 CM claims for services prior to implementation date will continue to flow through systems for a period of time 8
9 ICD 10 Code Freeze Decision Last regular, annual updates to both ICD 9 CM and ICD 10 would be made on October 1, 2011 Only limited ICD 9 CM & ICD 10 updates for new technologies and diseases on October 1, 2012 and for ICD 10 on October 1, 2013 Regular updates to ICD 10 beginning October 1,
10 Benefits of Adopting the New Coding System Updated medical terminology and classification of diseases; Allows easier comparison of mortality and morbidity data Provides better data for: Measuring care provided to patients; Designing payment systems; Processing claims; Making clinical decisions; Tracking public health; Identifying fraud and abuse; and Conducting research 10
11 ICD 10 CM Structure ICD 9 CM 3 5 characters First character is numeric or alpha (E or V) Characters 2 5 are numeric Always at least 3 characters Use of decimal after 3 characters ICD 10 CM 3 7 characters Character 1 is alpha (all letters except U are used) Character 2 is numeric Characters 3 7 are alpha or numeric Use of decimal after 3 characters Use of dummy placeholder x Alpha characters are not case sensitive
12 ICD 10 PCS Structure ICD 9 CM ICD 9 CM has 3 4 characters All characters are numeric All codes have at least 3 characters Alpha characters are not case sensitive Decimal after 2 nd character ICD 10 PCS ICD 10 PCS has 7 characters Each can be either alpha or numeric Numbers 0 9; letters A H, J N, P Z Alpha characters are not case sensitive Each code must have 7 characters No decimal
13 Summary of Differences: ICD 9 CM and ICD 10 Code Sets Diagnoses ICD 9 CM 14,025 codes ICD 10 CM 68,069 codes Procedures ICD 9 CM 3,824 codes ICD 10 PCS 72,589 codes 13
14 Why Aggregate Coded Data Remains Essentially the Same A code is an intermediate representation of something that occurred in the real world The number of different diseases in the world, and the number of procedures used to treat various conditions, has not ballooned overnight It s just that the intermediate representation has become more detailed Aggregate detail of a more detailed system is still aggregate detail
15 General Equivalence Mappings (GEMs) ICD 9 CM and ICD 10 CM/PCS codes are very different Tools needed to convert data Mapping is not the same as coding Mapping links concept in two code sets without consideration of patient medical record information GEMs are not a substitute for learning how to code with ICD 10 GEMs Designed to aid in converting applications and systems from ICD 9 CM to ICD 10 CM/PCS codes Bi directional mappings (backward and forward maps) Find and replace codes or lists of codes 15
16 GEMs (Continued) Why do we need GEMs? One ICD 9 CM code represented by multiple ICD 10 codes or one ICD 10 code represented by multiple ICD 9 CM codes There are new concepts in ICD 10 CM that have no predecessor in ICD 9 CM (e.g., under dosing, blood type) Use of GEMs very important in identifying differences that would have been highlighted if dual coding could have been undertaken 16
17 Which GEM to Use I 10 GEM Contains All I 10 Codes In order to find ALL the comparable ICD 10 CM/PCS codes, you need to look in the ICD 10 GEM (the source system GEM for ICD 10) Remember, not all of the ICD 10 codes are in the ICD 9 CM GEM
18 How the GEMs Work Translation depends on source Because the translation is based on the meaning of the source system code And these are two different languages of healthcare Then the GEMs may have different content in each direction Not all I 9 codes are used in an I 10 GEM Not all I 10 codes are used in an I 9 GEM Four ICD 9 CM codes translate to four ICD 10 CM codes Eight of these ICD 10 CM codes are not in the ICD 9 CM GEM
19 GEMs (Continued) Example from ICD 10 CM Diagnosis mapping ICD 10 CM Source system code on the left side ICD 9 CM Target system code in the middle Flags on the right T500x1A T500x1A E T500x1D T500x1D E T500x1S T500x1S E T500x2A T500x2A E T500x2D T500x2D E T500x2S T500x2S E
20 How do I read the GEMs? Flags Read as 1=On/Yes 0=Off/No Three different flags Approximate No Map Combination PCS to I 9 + flags 02733ZZ ZZ ZZ ZZ ZZ ZZ
21 ICD 10 CM/ICD 10 PCS Transition for Morbidity Training IT systems Other specific issues Analysis and Reporting
22 Training Training issues ICD 10 basics for secondary users Epidemiologists Statisticians IT Personnel End Users Contract coding staff Assessing readiness
23 Training Issues Training issues Overview of differences between ICD 9 CM and ICD 10 CM code sets Changes in terminology Traditional terminology versus standardized terminology of PCS (e.g., Anastamosis versus Bypass) Procedure codes don t include diagnosis (cataract extraction) Structural differences OB, Injuries, Subsequent encounter injury and poisoning codes
24 IT/Data Processing Redesign to accommodate alphanumeric codes 7 character codes, code title lengths Re writing or writing new programs System logic & edits System storage capacity Historical file storage New file storage Backup file storage
25 IT/Data Processing New computer edits Consistency checks Edits: Age, Sex Testing/validating systems use of new code sets For months of ICD 9 CM coded data 3 months of ICD 10 CM coded data
26 Analysis and Reporting Classification restructuring (e.g. Injuries) ICD 9 Fractures Dislocations Sprains/Strains ICD 10 Injuries to head Injuries to neck Injures to thorax S00 S09 S10 S19 S20 S29
27 Analysis and Reporting Trending Statistical tests to ascertain whether change between years of old revision and the first years of new revision is a statistically significant change Loss of information Very detailed information Data aggregation Redesign of publications and tables
28 Analysis and Reporting Detailed information Laterality Clinical and/or procedure detail Angioplasty Mechanical complications of vascular grafts Terminology Tonsillectomy vs. Resection of Tonsils Cesarean section vs. Extraction of Products of Conception
29 Future Analysis Considerations: ICD 9 CM Angioplasty Code ICD 10 PCS Angioplasty codes 854 codes What level of meaningful aggregation? By site? By approach? By device type? 047K04Z Dilation of right femoral artery with drug eluting intraluminal device, open approach 047K0DZ Dilation of right femoral artery with intraluminal device, open approach 047K34Z Dilation of right femoral artery with drug eluting intraluminal device, percutaneous approach 29
30 Analysis and Reporting: Report and Publication Redesign 30
31 Analysis and Reporting Report and Publication Redesign 31
32 Resources Helpful Web Sites ICD 10 CM/PCS Resources NCHS and CMS resources available that may help with ICD 10 CM/PCS implementation planning. Version 2010 ICD 10 CM, Guidelines and GEMs ICD 10 PCS Coding System, Training Manual and GEMs ICD 10 MS DRG conversion project asp#topofpage 32
33 Resources (continued) Helpful Web Sites ICD 10 CM/PCS Resources Many professional organizations also have resources available Vendor applications and availability NC Healthcare Information and Communications Alliance, Inc. American Health Information Management Association based model.html American Medical Association assn.org/ama1/pub/upload/mm/399/icd9 icd10 conversion.pdf American Hospital Association 33
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